Provider Demographics
NPI:1891751426
Name:WORKMAN, MARCY R (PA)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:R
Last Name:WORKMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40423-0006
Mailing Address - Country:US
Mailing Address - Phone:859-236-0916
Mailing Address - Fax:859-236-0917
Practice Address - Street 1:111 DANIEL DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2527
Practice Address - Country:US
Practice Address - Phone:859-236-0916
Practice Address - Fax:859-236-0917
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA342363AM0700X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100057230Medicaid
S60348Medicare UPIN